2017 Vol. 14, No. 9
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2017, 14(9): 541-546.
doi: 10.11909/j.issn.1671-5411.2017.09.009
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2017, 14(9): 547-552.
doi: 10.11909/j.issn.1671-5411.2017.09.002
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Background Acute stroke (AS) rates in patients over 90 years of age (very elderly) with atrial fibrillation (AF) in the United States (US) are not known. We assessed trends in hospitalizations for AS among very elderly with AF in the US from 2005 to 2014. Methods We used the nationwide inpatient sample (NIS) from the USA; 2005–2014. AF and AS diagnoses were abstracted using international classification of diseases, 9th Revision, clinical modification (ICD-9-CM) codes. Results From 2005–2014, 3,606,073 hospitalizations of very elderly with AF were reported. Of these, 188,948 hospitalizations (141,822 hospitalizations in women and 47,126 hospitalizations in men) had AS as the primary diagnosis. Age adjusted AS hospitalizations increased in the total cohort (3217/million in 2005 to 3871/million in 2014), in women (3540/million in 2005 to 4487/million in 2014) and in men (2490/million in 2005 to 3173/million in 2014) (P Conclusions There is an increasing trend in AS hospitalizations among nonagenarians with AF in the US despite improving utilization of anticoagulants in this patient population. The etiologies driving this alarming trend are unclear and require fur?ther study.
Background Acute stroke (AS) rates in patients over 90 years of age (very elderly) with atrial fibrillation (AF) in the United States (US) are not known. We assessed trends in hospitalizations for AS among very elderly with AF in the US from 2005 to 2014. Methods We used the nationwide inpatient sample (NIS) from the USA; 2005–2014. AF and AS diagnoses were abstracted using international classification of diseases, 9th Revision, clinical modification (ICD-9-CM) codes. Results From 2005–2014, 3,606,073 hospitalizations of very elderly with AF were reported. Of these, 188,948 hospitalizations (141,822 hospitalizations in women and 47,126 hospitalizations in men) had AS as the primary diagnosis. Age adjusted AS hospitalizations increased in the total cohort (3217/million in 2005 to 3871/million in 2014), in women (3540/million in 2005 to 4487/million in 2014) and in men (2490/million in 2005 to 3173/million in 2014) (P Conclusions There is an increasing trend in AS hospitalizations among nonagenarians with AF in the US despite improving utilization of anticoagulants in this patient population. The etiologies driving this alarming trend are unclear and require fur?ther study.
2017, 14(9): 553-562.
doi: 10.11909/j.issn.1671-5411.2017.09.010
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Objective To assess the incidence and predictors of heart rhythm and conduction disturbances in hypertensive obese patients with and without obstructive sleep apnea (OSA). Methods This is an open, cohort, prospective study. Out of 493 screened patients, we selected 279 hypertensive, obese individuals without severe concomitant diseases: 75 patients without sleep-disordered breathing (non-SDB group), and 204 patients with OSA (OSA group). At baseline, all patients underwent examination, including ECG, Holter ECG monitoring, and sleep study. During follow-up (on 3, 5, 7 and 10th years; phone calls once per 6 months), information about new events, changes in therapy and life style was collected, diagnostic procedures were performed. As the endpoints, we registered significant heart rhythm and conduction disorders as following: atrial fibrillation (AF), ventricular tachycardia, atrioventricular block (AV) 2–3 degree, sinoatrial block, significant sinus pauses (> 2000 ms), and the required pacemaker implantation. Results The median follow-up was 108 (67.5–120) months. The frequency of heart rhythm disorders was higher in OSA patients (29 cases, χ2 = 5.5; P = 0.019) compared to the non-SDB patients (three cases; OR: 3.92, 95% CI: 1.16–13.29). AF was registered in 15 patients (n = 12 in OSA group; P = 0.77). Heart conduction disturbance developed in 16 patients, without an association with the rate of coronary artery disease onset. Regression analysis showed that only hypertension duration was an independent predictor of AF (OR: 1.10, 95% CI: 1.04–1.16; P = 0.001). In case of heart conduction disturbances, apnea duration was the strongest predictor (Р = 0.002). Conclusions Hypertensive obese patients with OSA demonstrate 4-fold higher incidence of heart rhythm and conduction disturbances than subjects without SDB. Hypertension duration is an independent predictor for AF development, while sleep apnea/hypopnea duration is the main factor for heart conduction disorders onset in hypertensive obese patients with OSA.
Objective To assess the incidence and predictors of heart rhythm and conduction disturbances in hypertensive obese patients with and without obstructive sleep apnea (OSA). Methods This is an open, cohort, prospective study. Out of 493 screened patients, we selected 279 hypertensive, obese individuals without severe concomitant diseases: 75 patients without sleep-disordered breathing (non-SDB group), and 204 patients with OSA (OSA group). At baseline, all patients underwent examination, including ECG, Holter ECG monitoring, and sleep study. During follow-up (on 3, 5, 7 and 10th years; phone calls once per 6 months), information about new events, changes in therapy and life style was collected, diagnostic procedures were performed. As the endpoints, we registered significant heart rhythm and conduction disorders as following: atrial fibrillation (AF), ventricular tachycardia, atrioventricular block (AV) 2–3 degree, sinoatrial block, significant sinus pauses (> 2000 ms), and the required pacemaker implantation. Results The median follow-up was 108 (67.5–120) months. The frequency of heart rhythm disorders was higher in OSA patients (29 cases, χ2 = 5.5; P = 0.019) compared to the non-SDB patients (three cases; OR: 3.92, 95% CI: 1.16–13.29). AF was registered in 15 patients (n = 12 in OSA group; P = 0.77). Heart conduction disturbance developed in 16 patients, without an association with the rate of coronary artery disease onset. Regression analysis showed that only hypertension duration was an independent predictor of AF (OR: 1.10, 95% CI: 1.04–1.16; P = 0.001). In case of heart conduction disturbances, apnea duration was the strongest predictor (Р = 0.002). Conclusions Hypertensive obese patients with OSA demonstrate 4-fold higher incidence of heart rhythm and conduction disturbances than subjects without SDB. Hypertension duration is an independent predictor for AF development, while sleep apnea/hypopnea duration is the main factor for heart conduction disorders onset in hypertensive obese patients with OSA.
2017, 14(9): 563-568.
doi: 10.11909/j.issn.1671-5411.2017.09.008
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Background Although elderly patients have been included in published series of catheter ablation for atrial fibrillation (AF), clinical benefit and safety remain still less defined in this population. A retrospective analysis of the results of catheter ablation for AF in a large volume center focused on comparison of elderly patients with the rest of the patient cohort was conducted in this study. Methods Consecutive patients who underwent catheter ablation for AF between January 2001 and December 2016 were analysed. A total population of 3197 patients was dichotomized by the age of 70 years (394 elderly vs. 2803 younger subjects). Patients were followed in terms of arrhythmia status and sur?vival for a median period of 18 vs. 21 and 35 vs. 57 months, respectively. Results Elderly patients were more frequently females (49% vs. 29%, P vs. 57%, P P vs. 6%, P vs. 8%, P vs. 1.5 ± 1.2 s, P vs. 3.2%, P = 0.03); however, this difference was driven by vascular complications (3.6% vs. 1.9%, P = 0.04). There were comparable rates of cerebrovascular (0.3 vs. 0.3%) or nonvascular complications (1.8 vs. 1.2%). Good arrhythmia control was inferior in elderly patients as compared with the rest of the cohort, both without and with antiarrhythmic drugs: 44.2% vs. 58.2% (P vs. 83.2% (P Conclusions Catheter abla?tion for AF in elderly patients is safe although somewhat less effective. Good arrhythmia control is associated with better survival, especially in elderly patients.
Background Although elderly patients have been included in published series of catheter ablation for atrial fibrillation (AF), clinical benefit and safety remain still less defined in this population. A retrospective analysis of the results of catheter ablation for AF in a large volume center focused on comparison of elderly patients with the rest of the patient cohort was conducted in this study. Methods Consecutive patients who underwent catheter ablation for AF between January 2001 and December 2016 were analysed. A total population of 3197 patients was dichotomized by the age of 70 years (394 elderly vs. 2803 younger subjects). Patients were followed in terms of arrhythmia status and sur?vival for a median period of 18 vs. 21 and 35 vs. 57 months, respectively. Results Elderly patients were more frequently females (49% vs. 29%, P vs. 57%, P P vs. 6%, P vs. 8%, P vs. 1.5 ± 1.2 s, P vs. 3.2%, P = 0.03); however, this difference was driven by vascular complications (3.6% vs. 1.9%, P = 0.04). There were comparable rates of cerebrovascular (0.3 vs. 0.3%) or nonvascular complications (1.8 vs. 1.2%). Good arrhythmia control was inferior in elderly patients as compared with the rest of the cohort, both without and with antiarrhythmic drugs: 44.2% vs. 58.2% (P vs. 83.2% (P Conclusions Catheter abla?tion for AF in elderly patients is safe although somewhat less effective. Good arrhythmia control is associated with better survival, especially in elderly patients.
2017, 14(9): 569-574.
doi: 10.11909/j.issn.1671-5411.2017.09.004
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Background Atrial fibrillation (AF) is the most frequent arrhythmia, and its prevalence is increasing with aging. We aimed to compare the long-term outcome data of patients vs. ? 65 years who underwent catheter ablation (CA) for drug-refractory AF. Methods Consecutive patients with primary pulmonary vein isolation performed between March 2001 and December 2011, and those who completed a five-year of follow-up were divided into two groups: patients aged Results A total number of 390 patients were included, group 1 contained 310 patients, and 80 patients in group 2. In group 2, patients had more often impaired renal function (P P = 0.047). A total of fifteen patients died during the 6.63 ± 2.1 years of follow-up, with a significantly higher incidence in the older group (8/80 vs. 7/310 patients, P = 0.004). The majority of fatal outcome was due to cancerous diseases in both groups. No difference was observed concerning the long-term TE rate (12/310 vs. 4/80 patients, P = 0.75). Rhythm control failed in 25.9% of the patients, with no difference between the groups: 26.4% in group 1 vs. 23.7% in group 2 (P = 0.67). Conclusions Despite growing prevalence of AF in aging population, the elderly patients are underrepresented in CA procedures. Similar clinical success and TE complication rate are observed between the age-groups. Our data suggest more liberal criteria might be applied while selecting patients for AF ablation.
Background Atrial fibrillation (AF) is the most frequent arrhythmia, and its prevalence is increasing with aging. We aimed to compare the long-term outcome data of patients vs. ? 65 years who underwent catheter ablation (CA) for drug-refractory AF. Methods Consecutive patients with primary pulmonary vein isolation performed between March 2001 and December 2011, and those who completed a five-year of follow-up were divided into two groups: patients aged Results A total number of 390 patients were included, group 1 contained 310 patients, and 80 patients in group 2. In group 2, patients had more often impaired renal function (P P = 0.047). A total of fifteen patients died during the 6.63 ± 2.1 years of follow-up, with a significantly higher incidence in the older group (8/80 vs. 7/310 patients, P = 0.004). The majority of fatal outcome was due to cancerous diseases in both groups. No difference was observed concerning the long-term TE rate (12/310 vs. 4/80 patients, P = 0.75). Rhythm control failed in 25.9% of the patients, with no difference between the groups: 26.4% in group 1 vs. 23.7% in group 2 (P = 0.67). Conclusions Despite growing prevalence of AF in aging population, the elderly patients are underrepresented in CA procedures. Similar clinical success and TE complication rate are observed between the age-groups. Our data suggest more liberal criteria might be applied while selecting patients for AF ablation.
2017, 14(9): 575-581.
doi: 10.11909/j.issn.1671-5411.2017.09.007
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Background Prevalence of atrial fibrillation (AF) increases with age. Radiofrequency catheter ablation (RFCA) is an established treatment option superior to antiarrhythmics (AAs). In this study, we investigated safety and efficacy of RFCA of AF in octogenarians. Methods From our database, we extracted procedural and follow-up data for patients ≥ 80 years with symptomatic AF undergoing RFCA and compared this population to RFCA patients ≤ 50 years. All patients underwent pulmonary vein isolation (PVI) supplemented by linear lesions in PVI-nonresponders. Arrhythmia-free survival was assessed using seven day Holter every three months post procedure. All patients completed their 12 months follow-up. Results Fifty patients aged ≥ 80 years (80.5 ± 1.6 years) were compared to 259 patients aged ≤ 50 years (43.5 ± 5.5 years). The RFCA complication rate did not vary between groups. No differences in procedural characteristics were seen after being analyzed by type of AF. Among patients with paroxysmal AF, 71.4% octogenarian vs. 84.7% young patients was free of any arrhythmia, without AAs, after single procedure. For non-paroxysmal AF, arrhythmia-free survival without AAs, was considerably lower (58.6% octogenarians vs. 81.2% younger patients, P = 0.023). If AAs were used, arrhythmia-free survival for paroxysmal AF increased to 90.5% and 92.1% in octogenarians and younger patients, respectively; and in non-paroxysmal AF it increased to 79.3% vs. 88.4%. Conclusions RFCA is a safe and effective strategy to achieve normal sinus rhythm in a highly selected group of octogenarians. Paroxysmal AF ablation in octogenarians has similar clinical effectiveness as that seen in much younger patients. Non-paroxysmal AF ablation has lower, but still reasonable clinical effectiveness.
Background Prevalence of atrial fibrillation (AF) increases with age. Radiofrequency catheter ablation (RFCA) is an established treatment option superior to antiarrhythmics (AAs). In this study, we investigated safety and efficacy of RFCA of AF in octogenarians. Methods From our database, we extracted procedural and follow-up data for patients ≥ 80 years with symptomatic AF undergoing RFCA and compared this population to RFCA patients ≤ 50 years. All patients underwent pulmonary vein isolation (PVI) supplemented by linear lesions in PVI-nonresponders. Arrhythmia-free survival was assessed using seven day Holter every three months post procedure. All patients completed their 12 months follow-up. Results Fifty patients aged ≥ 80 years (80.5 ± 1.6 years) were compared to 259 patients aged ≤ 50 years (43.5 ± 5.5 years). The RFCA complication rate did not vary between groups. No differences in procedural characteristics were seen after being analyzed by type of AF. Among patients with paroxysmal AF, 71.4% octogenarian vs. 84.7% young patients was free of any arrhythmia, without AAs, after single procedure. For non-paroxysmal AF, arrhythmia-free survival without AAs, was considerably lower (58.6% octogenarians vs. 81.2% younger patients, P = 0.023). If AAs were used, arrhythmia-free survival for paroxysmal AF increased to 90.5% and 92.1% in octogenarians and younger patients, respectively; and in non-paroxysmal AF it increased to 79.3% vs. 88.4%. Conclusions RFCA is a safe and effective strategy to achieve normal sinus rhythm in a highly selected group of octogenarians. Paroxysmal AF ablation in octogenarians has similar clinical effectiveness as that seen in much younger patients. Non-paroxysmal AF ablation has lower, but still reasonable clinical effectiveness.
2017, 14(9): 582-586.
doi: 10.11909/j.issn.1671-5411.2017.09.003
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2017, 14(9): 587-589.
doi: 10.11909/j.issn.1671-5411.2017.09.005
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2017, 14(9): 590-592.
doi: 10.11909/j.issn.1671-5411.2017.09.006
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2017, 14(9): 593-594.
doi: 10.11909/j.issn.1671-5411.2017.09.001
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2017, 14(9): 595-596.
doi: 10.11909/j.issn.1671-5411.2017.09.011
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